Provider Demographics
NPI:1952469645
Name:THAKRAL, NELAMBARI (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:NELAMBARI
Middle Name:
Last Name:THAKRAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 703207
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-0994
Mailing Address - Country:US
Mailing Address - Phone:313-359-9595
Mailing Address - Fax:313-359-9585
Practice Address - Street 1:261 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4968695Medicaid
MI650H230490OtherBCBS BCN
MI7451962OtherAETNA
MIP00627865OtherRAILROAD MEDICARE
MI7451962OtherAETNA